No Breathing Room: The Asthma Epidemic
January 15, 2008
The lucky kids can sleep through the night without gagging, or can run down the basketball court without worrying about a hospital visit. Breathing is never a conscious activity. But for the 6.5 million Americans under 18 with asthma, the most banal actions can set off a physical response that is uncomfortable at best and deadly at worst.
Asthma is now the most common chronic ailment among children in the United States; the number of young people afflicted has skyrocketed in recent years. According to the Centers for Disease Control and Prevention (CDC), the prevalence of asthma in children rose 60 percent from 1980 to 2003, and low-income children of color are the most impacted. While small-scale reforms have helped teach kids the best ways to ease the manageable disease's symptoms, structural fixes remain largely unaddressed, a disappointing trend given the severity of the epidemic in cities nationwide.
Asthma is a chronic respiratory condition in which a person's bronchial tubes (airways) become swollen and extra mucus blocks air from reaching the lungs. For many, it will never be a concern, because one must have a genetic predisposition toward the malady for it to manifest. But if a person is genetically wired for asthma, a host of environmental conditions can trigger unpleasant--and in some situations dangerous--attacks.
Historically, the effects of allergens, or substances that cause allergic reactions, have garnered the most attention from researchers and clinicians. Indoor pollutants like mold, dust mites, animal dander, and secondhand tobacco smoke have all been identified as asthma enablers. Equally dangerous are outdoor aerial toxins, such as fuel exhaust from cars, trucks and buses, ragweed, and pollen. If an asthmatic child consistently breathes air of substandard quality, it's likely their attacks will become more frequent.
Of course, given the deliberate placement of highways, industrial factories, airports, and other emitting infrastructure in American cities, poor youth are bombarded with a disproportionate amount of poisons. Frighteningly enough, as climate change warps the environment, these airborne toxins may strengthen, too. In a 2004 report, the American Public Health Association and researchers from Harvard University concluded that a "powerful one-two punch" of elevated pollen levels and modifications in the types of molds incited by climate change will boost the asthma rates of children in America's cities.
But ecological factors only account for a portion of asthma's underlying causes. Research now suggests that the excess stress of inner-city living can increase psychosocial risk factors by disrupting one's immune system, causing hypersensitive and easily inflamed lungs. Exposure to violence, economic hardship, or familial breakdowns can all contribute.
Dr. Rosalind Wright, an Assistant Professor of Medicine at Harvard Medical School and an associate physician at Brigham and Women's Hospital, has studied these symptoms intensely. She calls them social pollutants. "If you start to look at the science behind how emotion disrupts physiology and the body, it's operating through parallel pathways," she says. "So when you start to visualize these ... pollutants that get breathed in the same way that you breath in an allergen, it's going to set off some of those same pathways."
While both social and environmental contaminants can set off asthma independently, together they make the condition even more powerful. "When two different toxicants are getting in the body and operating through parallel systems," says Wright, "they are going to enhance each other."
Good information and solid preventive health care is necessary to understand these complex factors and to control asthma symptoms, but parents of city youths can have a harder time obtaining either. "[Inner-city parents] have enough to do just to have the kids fed and dressed," says Dr. Paul Ehrlich, a leading pediatric asthma specialist and Clinical Assistant Professor of Pediatrics at New York University School of Medicine. "Many don't have jobs where they can take off the morning and take a child to the specialist."
Thus, the reinforcing relationship between decades of environmental racism, amplified stress levels, and lackluster health care coverage explains why levels of asthma are considerably higher in poor, urban America--where a disproportionate number of children of color reside--than in suburbs or on farms. While asthma rates in the broader population have begun to plateau, overall rates for black and Latino children remain steadily 30 to 100 percent higher than for white children. Puerto Ricans are hit the hardest, registering rates 140 percent higher than for non-Hispanic whites.
The School Factor
What results from our inability to control a wholly treatable ailment? For starters, children are forced to neglect crucial responsibilities. Asthma is the leading cause of school absences--accounting for 13 million missed days per year--that can result in low grades, missed extracurricular activities, and social isolation.
Also, when asthma is not treated early, the cost of care soars. Because too few people have the means or knowledge to keep their disease under control, hospital trips have become a common destination for asthmatics; the CDC notes that one in four emergency room visits nationwide is asthma-related, totaling 5,000 per day. Combined with medication and specialist visits, $19.7 billion is spent on asthma treatment annually.
Perhaps most unsettling, asthma can lead to more than just discomfort. "Any time that childhood asthma goes unrecognized and untreated," says Wright, "there can be potential long-term consequences." In 2004, the last year the American Lung Association calculated such totals, 3,816 people died of asthma. While this represented an encouraging drop in the overall death rate--5,600 perished in 1996, for example-- some contend that the current number may double by 2020. And black people were six times more likely to die than whites.
While eradicating the environmental and social toxins that plague American cities is complicated, especially because the needs of poor Americans are often disregarded by policy makers, small strides have been made to mitigate asthma severity. Educators are one population that is taking childhood asthma treatment seriously, a hopeful development given the central role of education in minimizing disparate risks. According to Ehrlich, schools are also required to use every available resource to make sure children are able to attend, under the Elementary and Secondary Education Act passed in 1965 by the Johnson Administration. "It's taken the schools and caregivers a long time to meet up to those standards," says Ehrlich, "but over the last 40 years, finally the schools have come to do it."
One such program is Ehrlich's Project E.R.A.S.E. (Eradicating Respiratory Asthma in Schools to help children Excel), an in-school plan that offers New York City schoolchildren free diagnosis and advice on asthma treatment. Asthma doctors are sent into targeted schools where they treat kids with the disease, identify undiagnosed cases, and meet with parents, caregivers and educators to provide information and support that will develop vital asthma management skills. "Assuming that they may never make it to the specialist," says Ehrlich, "we make sure that the specialist gets to them." Another example is the American Lung Association's Open Airways For Schools asthma management program, which offers 8-11 year olds in-school group lessons promoting basic information about asthma and its sources.
Time For Action
But these efforts, while effective on a small scale, cannot overcome the multifactorial nature of the childhood asthma epidemic on their own. To eliminate the root causes of the respiratory ailment, broad policy reforms are necessary. If seen in the right way, the asthma plague could provide a unique opportunity for effective and rare coalition-building among activists of diverse stripes. Environmentalists troubled by carbon output and urban pollution could partner with anti-violence community activists, healthcare workers and affordable housing advocates, all in the name of protecting American cities and the children who inhabit them. But so far, no coalition has filled this vacuum.
Wright is first to acknowledge both the hindrances against and the necessity of building such coalitions. "That's a very difficult thing to figure out how to do, to engage in the community," she says. "[But] that's got to happen at the local level, and it also has to happen even more broadly."
Adam Doster is a recent graduate of University of Michigan, former managing editor of the Michigan Independent and current freelance reporter based in Chicago.